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�._.PPLICATION FO.� V <br /> p`°f""'"" CONSTRUCTION °"e G� <br /> everett PERMIT .[� <br /> BUILDING DEPARTMENT \ <br /> 259•8745 TO VE COMPLETED IN INK• PLEASE PRINT v <br /> ❑ DEMOLITION LJ COMBINATION ❑ BUILDtNG ❑ MECHANICAL ❑ PLUMB�NG �E7 SIGN� <br /> pWbLB MqL�ODRE55 d1V ZIP PNONE <br /> ��L�72�Yh77U /J7c fi il i .C�i S�7ri C .�7�f��%�s �ri C72.4�c7T ,[��. <br /> ♦IICNtl[�IbqpC5lGNfR M�IL��ORE39 CIfY 21P PNONE <br /> .INUULCON�R�plpp (^ MM� �DORE55 G1Y ZIP PHONE UCENSE• <br /> /�`Rr.^ ��T .\/CX�S G""L'i�-71-E7T i�Y1_ 15��-JZ��f`s Ta tF 1 <br /> MI6UNiGLCONIRA[IOq MMLAODRE55 ` �9S /�/ �~` <br /> ��n' IIP FNONE L�CCNSC• <br /> 1'WMBM.LONIP�CIOR M�IL�ODRF.53 CITY 2iP PIIONE ��[�q5�• <br /> CU550f WONM <br /> jL� NEW ❑ ADDITION ❑ AL7ERRTION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTCIVE/FRPL.INSERT C� DUILDiNG RELOCATION <br /> vM9���ONorwonK�Co51orM�l�me�.srRUSL�BOP -�� — <br /> c��x'?'1 <br /> Itl SCRIpi WOR� - ' � — <br /> �- A�6v=-iCi �.l•:,rs 6 \S ' i �-��' _cA �' i O_ _ <br /> �is� nr aun niNa - <br /> I HEREBY CERT' THAT I HAVE READ ANU EXAMINED THIS AP� <br /> PLICATION AND KNOW THE SAME TO BE TRUEAND CORRECT.ALL <br /> �f(i�lOE:.CftO+ilUN01'PROP[NIY�SNUWNOCI.OWOR�II�C11p0URGOPIES� pROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> OF WORK WILI BE COMPLETED WITH WHETHER SFECIFIED HERE- <br /> �oi_e�oc�or IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME i0 <br /> GIVE AUTHORITY TO VIOLATE OR CANCEI THE PROVISIOIJS OF <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUC110N <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIGNATUREOFWNIRA�TORO�ORI2EOnGFNi � ORIE <br /> X �., � ,�,�. .`_ ,� �- ' <br /> �'NOICC�ADONL55 ( �P Ni5L1IYBU51HE5. IC ENO <br /> a�� � c�7�1.� J J <br /> PLUMBIN6 MECHANICAL <br /> NO. TYPE OF FIKTURE FEE NO. TVPE OF EOUIPMENT FEE <br /> WATER CLOSEi�iOI�ED qIR COND.UNITS-MP.EA. <br /> BATNTUB qEFRIGERATION UNITS-HP.EA. <br /> I.RVATORY�WASH BAS�N� BOILERS-HP.EA. <br /> SNOWEH GAS FIRED AC.UNITS-TONNAGE EA. <br /> _ NRCI.cN SINK 8 DISP. FORCED AIR SYSTEMS-B.T.U. M EA. <br /> DISHWASHER WAILHEATERS-B.T.U. M <br /> LAUNDRYTqAV UNITNEATERS-B.T.U. M <br /> CLOTHES WASNER EVAPORATIVECOOLERS <br /> _ WATER HEAIER CLOTHESDRYERS <br /> URINAL VENTILATION FAN <br /> URINKING FOUNTAIN RANGE HOOD <br /> FLOOR DRRIN AIR I/ANDLING UNIi- QF.M. <br /> VACWM BREAKEFS STOVE <br /> ROOF DRAINS-RAINLEADERS METAL FlREPLACE 6 CHIMNEY <br /> _ SINN ISERVICE-BAR,EiL WOODSTOVE/FIREPLACE INSERT <br /> SUBTOTAL SUB TOTAL S <br /> _ PERMIT 3 PERMIT S <br /> __ TOTqLFEE f TOTALFEE f <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> ��UNItifIp�CK O[�qSf.IBFCtl $IOESEfBACN PL�NGMECNNUM9ER Pl<Npq�MilC � <br /> r[[ n�C[im r�a <br /> "•I tOrvC LOfABL� V�CANTSRE - -- <br /> ❑YES ONO FEES V�LUATION fEE <br /> ��40lLO!151 OCLU��NCYGODUP . NOAFOWELLINOUNIIS <br /> OWLDING S <br /> �JI.UI OI Of. NO Of S10BIE5 MAk.OGC.IOAp _ <br /> PLUMBING <br /> MEGHANIGAL <br /> ���E SPRINKLERS RFpU1RED CI YES ❑ NO -- <br /> OTIIER <br /> PENRITY <br /> �'I'111:�IlONLf,COv PL�NSCIIFCRLOBY 11PPp.fOR155U�NCEBY _ <br /> TOT�L <br /> I I I I I ' � �U f��_+ /l 1"/�I _ <br /> GF �- ,� ,,., t-ac�c� <br /> 7� /c�� c� �:�,{ . <br />